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Upstream WashingtonState Plan Overview
January 2018
2
Overview
Introduction to Upstream • The Problem of Unplanned Pregnancy • Unplanned Pregnancy in Washington • Upstream’s Model• Our Progress in Delaware
Our Plan for Washington • Project Scope and Timeline • Evaluation Approach • Advisory Committee Mandate
Conclusion
3
The Opportunity Problem
2 out of 3 American children born into the lowest two income quintiles stay there as adults.
Across the country, economic opportunity has stalled.
Interventions are not working quickly enough to address intergenerational poverty in the United States.
4
Unplanned Pregnancy’s Role
1.5 MILLIONunplanned births per year in the U.S.
1 million of those are born into poverty
5
Unplanned Pregnancy’s Role
Unplanned pregnancy can cause women to drop out of school, disrupt their careers, and lead to poorer birth outcomes for children, all of which limit economic and educational opportunity.
50%
Half of these pregnancies occur to women using contraception.
Source: Guttmacher Institute, based on latest available data (2010) 6
Unplanned Pregnancy in Washington
In 2010, unplanned pregnancies in Washington resulted in 31,500 unplanned births.
48%of all pregnancies in Washington are unplanned
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The Cost of Unplanned Pregnancy
63%of unplanned births in WA are publicly funded
$177Min state costs in 2010
1. Source: Guttmacher Institute, based on latest available data (2010) 8
Unplanned Pregnancy in Washington
Women in greatest need of publicly-funded contraceptive services make up the bulk of unplanned pregnancies in Washington.
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Our Mission
Upstream USA is a nonprofit organization that helps health centers across the country eliminate barriers that prevent women from obtaining the full range of contraceptive methods so that all women are empowered to become pregnant only when they want to.
+Specialized Training
Train health centers to make reproductive care standard care by educating them on all FDA-
approved contraceptive services and coaching them to routinely ask women about their plans
for pregnancy
Technical InterventionsHelp health centers make lasting operational changes to ensure that all women will have
single-visit access to the full range of contraceptives, including long-acting reversible
contraceptives (LARCs)
Sustainable solutions to the five biggest barriers to LARC access:
Lack of trained providers
Screening for pregnancy intention
Issues billing, coding and stocking
LARCs Clinic workflow Consumer
awareness
=
Consumer Marketing Once health centers are able to deliver best-in-
class care, launch a consumer marketing campaign to make women aware of the
contraceptive services provided by health centers in their region
+
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Our Model
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Our Trajectory
Established in 2014, Upstream has grown from training individual health centers to a state-wide initiative in DE, and now, WA
2014 2015 2016 2017 2018 +
• Upstream founded• First health center
trained in Texas• Reach of 4,000 women
of reproductive ageper year• First meetings with
Delaware governor
•Upstream trained health centers in Arizona, New York, Massachusettsand Ohio•Combined reach of 35,000+ women of reproductive age/yr.
• Upstream trained 55 sites in Puerto Rico in response to the Zika virus• Official launch of first
statewide initiative, Delaware CAN• Reach of 100,000+
women of reproductive age/yr.
• Delaware CAN reaches majority of health centers + hospitals in the state• Combined reach of
136,000+ women of reproductive age/yr.• Creation of strategic
plan for growth that identifies Massachusetts and Washington State as central to Upstream’s expansion
• Delaware CAN completed• Upstream scales to 3
states, including Washington State and Massachusetts, to reach 1.6 million women by 2023
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In Action
In Massachusetts, we’ve transformed the operations of Family Health Center of Worcester, an FQHC serving primarily low-income patients
“When a woman comes in to see her provider and she’s interested in talking about the timing of her family…we can say to her, ‘we have great choices for you.’ We didn’t used to be able to say that.”
Tracy Kedian, MD, Family Health Center of Worcester
Video Link: https://www.youtube.com/watch?v=QC5CQm3Z4O4
1494 Staff trained
Sites trained160
136KWRA reached
513Clinicians trainedWe have reached health
centers serving 73% of the women of reproductive age (WRA) in Delaware.
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Progress to Date in Delaware
5.9% 7.5%
20.5%
2014 2015 2016
Upstream intervention start (late 2014)
1. Source: PPDE Title X data: % of all women aged 15-44, excluding those pregnant or seeking pregnancy 14
Our Results: Planned Parenthood of Delaware
LARC End Method Rates, 2014 – 20161
4.6% 5.4% 6.2%
11.5%
15.4%
2012 2013 2014 2015 2016
1. Source: Title X data: % of all women aged 15-44, excluding those pregnant or seeking pregnancy 15
Our Results: Delaware Title X Sites
Upstream intervention start (late 2014)
End Method Rates, 2012-20161
As we begin to scale in Washington State, our focus will be selecting and preparing partners that enable us to meet our goals for impact.
540,000 Women of reproductive age (WRA) reached by heath centers served when project is complete
Public and private health sites receive training and technical assistance300
Years of training and technical assistance delivery, starting in 2019 5Participating agencies; including FQHCs, Tribal and IHS providers, rural health centers, and private providers serving a high percentage of Medicaid patients 40
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Washington: Our Planned Scope
Our planned timeline allows us to build a strong, statewide infrastructure to support transformation in the healthcare system.
2017 2018 2019 2020 2021 2022 2023 2024 2025Infrastructure Build• Recruit agencies• Build relationships• Establish offices
In-State Monitoring, Evaluation and Learning• Continuous evaluation of our intervention (both real-time monitoring and a separate, independent evaluation)
Training Delivery and Follow-On Technical Assistance
• Deliver comprehensive, day long training to all clinical and support staff • Provide comprehensive and tailored follow-on technical assistance to ensure sites implement
same-day access to all FDA-approved forms of birth control
Health Center Prep and Pre-Training Technical Assistance• Evaluate site readiness for training and technical assistance and provide pre-training interventions,
including billing and coding training, device stock up, and workflow changes
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Washington: Our Project Timeline
Our first cohort of agencies will be determined based on the availability of data, patient population, and leadership at their sites.
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Launch Agency Selection Criteria
• Influential leadership willing to address barriers to implementation• Engaged, motivated leaders among administration and clinicians• Staff who are engaged and committed to offering quality contraceptive care • Familiarity with using data to inform quality improvement• Openness to data extraction + our planned third party platform partner (Azara)• Serves a population in need of high-quality contraceptive care
Selection Criteria
Our Advisory Committee will be key to success in Washington.
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Advisory Committee Mandate
Upstream is seeking engaged leadership from the healthcare community across Washington to serve on an Advisory Committee that will help the organization consider the unique challenges and opportunities of bringing this work to scale in Washington.
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Conclusion
Upstream’s work shows that reducing unplanned pregnancy nationwide is possible within the next decade. Our progress in Delaware has proved that a statewide effort can improve access to effective contraception, in a sustainable way with lasting impact.
Despite progress in making LARCs more accessible in Washington, there is still significant room for improvement, and leaders in government, healthcare, and advocacy are aligned in support of our efforts.
The Washington Plan is a unique opportunity to dramatically reduce teen pregnancy, unplanned pregnancy, and abortion, while increasing opportunity and saving the government money.
Downstream, Upstream will have a significant impact on intergenerational poverty.
